The carpal tunnel is a narrow passage between the wrist and the palm. It is formed by the bones of the wrist and fibrous tissue in the palm. The median nerve, as well as the tendons, run through this space. The median nerve can become compressed. This results in pain, numbness and tingling in the fingers (especially the thumb, middle and index finger) and a weakened grip. This is known as carpal tunnel syndrome.
Symptoms of carpal tunnel syndrome include the following:
- pain, pins and needles and numbness in the palm, thumb, index and middle finger;
- a weakened grip (difficulty holding small objects, buttoning a shirt, gripping the steering wheel for example);
- wasting of the muscles at the base of the thumb.
Most commonly, thickening of the overlying fibrous tissue causes carpal tunnel syndrome. There may be no definite underlying cause for this thickening. Carpal tunnel syndrome can also be associated with:
- pregnancy – the fluid retention associated with pregnancy can cause swelling around the carpal tunnel, compressing the median nerve;
- wrist dislocations and fractures;
- bone or arthritic conditions of the wrist such a rheumatoid arthritis;
- side effects of some medicines for example the combined oral contraceptive pill can disrupt the hormonal balance enough the cause carpal tunnel syndrome;
- other medical conditions that cause increased water retention in the body such as obesity, diabetes or menopause;
- work – repetitive wrist and hand movements and / or use of vibrating tools increase the risk of developing carpal tunnel syndrome.
Dr Laban will thoroughly assess your condition, discussing your symptoms, your medical history and he will examine you. Tests may then be recommended. These might include:
- nerve conduction studies and electromyography to determine the site of nerve injury;
- cervical spine MRI to rule out spinal cause for symptoms;
- wrist imaging to rule out rarer causes of carpal tunnel syndrome.
If symptoms persist and are not relieved by medication, exercises or splinting then surgery may be an option.
The goal of carpal tunnel surgery is to relieve pressure on the median nerve. A small incision is made in the palm and the abnormal fibrous tissue is divided releasing the median nerve.
The procedure is performed as a day case with patients returning home the same day. Bandages can be removed three to four days following the operation. You will have a small dressing over the incision which should be kept clean and dry. Sutures can be removed two weeks after surgery. To help prevent swelling in the fingers, you can keep the hand raised e.g., in a sling or on pillow when resting, and wiggle the fingers and make a fist regularly. Dr Laban advises only using the hand for light activities for the first six weeks. Hand physiotherapy can be useful and help guide return to normal activities. Return to work depends on profession. Complete recovery may take six to twelve weeks.